A case of spontaneous rupture of hepatocellular carcinoma mimicking a diaphragm tumor: Reconstruction of the diaphragm using a latissimus dorsi muscle flap

Spontaneous rupture of hepatocellular carcinoma (HCC) is sometimes encountered clinically. We experienced a case of spontaneous rupture of a HCC, which was surgically resected along with the diaphragm. A 74-year old woman presented with anemia. Preoperative imaging suggested a tumor arising on the diaphragm. After thoracotomy and laparotomy, the intraoperative diagnosis was changed to spontaneous rupture of a HCC with invasion to the diaphragm and right lower lung. Wide resection of the diaphragm including an area measuring 13 × 10 cm, partial resection of the right lower lung and right hepatectomy were performed. The defect in the diaphragm was reconstructed by suturing with a reversed latissimus dorsi muscle flap. There was no recurrence of HCC 7 years after surgery. Furthermore, the patient had no muscle weakness in the right arm during daily living activities. In conclusion, a good outcome may be obtained by combined resection of a ruptured HCC along with the diaphragm, even if the tumor has infiltrated the diaphragm. A latissimus dorsi muscle flap is considered to have a better antibacterial effect than an artificial mesh prosthesis, and is suitable for patients requiring wide resection of the diaphragm.